MEDICARE: MRS. TARA LYNN HAMILTON NNP-BC, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0000X	Neonatal Nurse Practitioner	705864	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP117716	TX

General Provider Information

NPI Number	:	1568604312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA LYNN HAMILTON NNP-BC, PMHNP-BC

Provider Business Mailing Address
First Line	:	11754 JOLLYVILLE RD STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-3948
Country	:	US
Telephone Number	:	512-331-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	11754 JOLLYVILLE RD STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-3948
Country	:	US
Telephone Number	:	512-331-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	07/05/2022

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